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Frequently Asked Questions About Joint Replacement

Posted on: 11/30/1999
Finally, patients get a chance to ask whatever questions they like of their surgeon before having a total joint replacement. If you are thinking about getting a new hip or knee, you'll find the information in this article helpful. Surgeons from two well-known hospitals take a look at questions such as these:

  • Should I have a joint replacement?
  • When's the best time to have this surgery?
  • Am I too old, too fat, or too young for a joint replacement?
  • What can go wrong?
  • What other choices are there besides surgery?
  • Where should I go to have this operation?
  • How do I find the right surgeon?

    Questions like these (and the answers) are important because they help patients make informed decisions about what's best for them. Social and cultural values play an important role in each patient's life. The surgeon doesn't always know what all the factors are that go into the patient's decision to have a joint replacement.

    For example, studies show that women are less likely to have a total joint replacement compared with men. They are afraid they will become a burden to their families after surgery. African Americans rely more on alternative approaches (e.g., prayer) for their arthritis before considering surgery. African American men do not expect much from the surgery, so don't see the need to have it.

    The surgeon takes each patient's preferences and beliefs into account. Patient education to help improve expectations and outcomes is an important part of the surgeon's role. Educational videotapes and reading materials can be very helpful in showing patients all sides of the issues. Surgeons are advised to keep an open line of communication with their patients and to adopt a shared decision-making approach.

    Here are some guidelines and factors that may help patients when faced with the decision of whether, when, and how to have a total joint replacement:

  • Consider having a joint replacement when pain and loss of function interfere with your life. Try conservative care first (medications, physical therapy) and give it a good, long trial. You have nothing to lose. Even if you have to convert to a joint replacement, you'll have better motion, strength, and function going into the surgery than you would have otherwise.
  • After recovery from the surgery, you can expect significant relief of pain and improved function in all areas of daily living. Most patients (90 per cent) report good-to-excellent results at the end of six months. They say they would recommend it to others and they would do it over again if they had the chance.
  • Any surgery has risks. The risks are small but still represent a portion of patients who run into trouble with blood clots, pneumonia, heart attacks, infection, and/or poor wound healing. Death occurs in approximately 0.6 per cent of all total knee patients (that's less than one person in 100). The risk is higher for total hip patients.
  • Age is no longer a primary limiting factor. More older adults are having this type of surgery, but younger adults with chronic joint pain and joint destruction are eligible. Considerations vary from young to old. Younger patients must be concerned about the life of the implant (how long will it last? Will they outlive their new joint and need another replacement?). Older adults with other health problems are at greater risk for complications after surgery.

    These are just a few of the many considerations that are covered in this article. Other areas of concern such as the effects of obesity in the decision-making process are discussed. Obesity leads to an earlier joint replacement compared with adults who are not obese. The more overweight a patient is, the greater the risk for complications and worse the results afterwards.

    But obese patients aren't discouraged from having the surgery. There are many examples of overweight and/or obese patients who lose weight after surgery because they can move again. That's an extremely important factor to consider.

    For those who aren't ready to take the plunge, conservative (nonoperative) care is still an option. Herbs, supplements, naturopathic treatment, and of course, weight loss when possible give many people pain relief and help delay surgery.

    Exercise has been proven effective in the successful management of osteoarthritis. A program of prescription exercises designed for each individual is available through a physical therapist. The therapist can also evaluate patients for bracing, shoe modifications, and/or shoe orthotics (inserts) to align and support the feet.

    The timing of the operation remains an individual decision. What is optimal for one patient may not be best for someone else. Things to consider are overall health of the patient, functional status before surgery, and pain level. Sometimes a pre-operative rehab program is a good idea. Recovery is faster with less time in the hospital. Most patients are out of the hospital in a matter of days. Complete recovery still takes several months.

    As to who should do the surgery -- studies support choosing a surgeon who does more than 50 total joint replacements each year. There are fewer complications and better functional outcomes when an experienced surgeon does the surgery. Look for high-volume surgeons in high-volume hospitals or clinics.

    Even under the best of circumstances, patients should know that they don't always go directly home from the hospital. Sometimes they are transferred from the hospital to a transitional care unit (TCU) where they receive continued rehab and support services until ready for discharge.

    Most patients continue to need a walker, crutches, or cane for support when walking. Visits to the physical therapist continue for several weeks to several months. A gradual tapering off of services while experiencing increase in function is common. Knowing what to expect when heading into a major decision such as surgery for a total joint replacement can help patients navigate the process.

  • References:
    Yvonne C. Lee, MD, and Jeffrey N. Katz, MD. Shared Decision Making for Total Joint Replacement: The Physician's Role. In The Journal of Musculoskeletal Medicine. November 2008. Vol. 25. No. 11. Pp. 513-520.

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